scholarly journals Graft Tensioning in Superior Capsular Reconstruction Improves Glenohumeral Joint Kinematics in Massive Irreparable Rotator Cuff Tears: A Biomechanical Study of the Influence of Superior Capsular Reconstruction on Dynamic Shoulder Abduction

2020 ◽  
Vol 8 (10) ◽  
pp. 232596712095742
Author(s):  
Felix Dyrna ◽  
Daniel P. Berthold ◽  
Lukas N. Muench ◽  
Knut Beitzel ◽  
Cameron Kia ◽  
...  
Keyword(s):  
Rotator Cuff ◽  
Glenohumeral Joint ◽  
Shoulder Function ◽  
Joint Kinematics ◽  
Biomechanical Study ◽  
Rotator Cuff Tears ◽  
Shoulder Abduction ◽  
Mean Values ◽  
Superior Capsular Reconstruction ◽  
Significant Difference

Background: Superior capsular reconstruction (SCR) for massive, irreparable rotator cuff tears has become more widely used recently; however, ideal tensioning of the graft and the influence on joint kinematics remain unknown. Purpose/Hypothesis: The purpose of this study was to assess the effects of graft tensioning on glenohumeral joint kinematics after SCR using a dermal allograft. The hypothesis was that a graft fixed under tension would result in increased glenohumeral abduction motion and decreased cumulative deltoid forces compared with a nontensioned graft. Study Design: Controlled laboratory study. Methods: A total of 10 fresh-frozen cadaveric shoulders were tested using a dynamic shoulder simulator. Each shoulder underwent the following 4 conditions: (1) native, (2) simulated irreparable supraspinatus (SSP) tear, (3) SCR using a nontensioned acellular dermal allograft, and (4) SCR using a graft tensioned with 30 to 35 N. Mean values for maximum glenohumeral abduction and cumulative deltoid forces were recorded. The critical shoulder angle (CSA) was also assessed. Results: Native shoulders required a mean (±SE) deltoid force of 193.2 ± 45.1 N to achieve maximum glenohumeral abduction (79.8° ± 5.8°). Compared with native shoulders, abduction decreased after SSP tears by 32% (54.3° ± 13.7°; P = .04), whereas cumulative deltoid forces increased by 23% (252.1 ± 68.3 N; P = .04). The nontensioned SCR showed no significant difference in shoulder abduction (54.1° ± 16.1°) and required deltoid forces (277.8 ± 39.8 N) when compared with the SSP tear state. In contrast, a tensioned graft led to significantly improved shoulder abduction compared with the SSP tear state ( P = .04) although abduction and deltoid forces could not be restored to the native state ( P = .01). A positive correlation between CSA and maximum abduction was found for the tensioned-graft SCR state ( r = 0.685; P = .02). Conclusion: SCR using a graft fixed under tension demonstrated a significant increase in maximum shoulder abduction compared with a nontensioned graft; however, abduction remained significantly less than the intact state. The nontensioned SCR showed no significant improvement in glenohumeral kinematics compared with the SSP tear state. Clinical Relevance: Because significant improvement in shoulder function after SCR may be expected only when the graft is adequately tensioned, accurate graft measurement and adequate tension of at least 30 N should be considered during the surgical procedure. SCR with a tensioned graft may help maintain sufficient acromiohumeral distance, improve clinical outcomes, and reduce postoperative complications.

Relationship Between Deltoid and Rotator Cuff Muscles During Dynamic Shoulder Abduction: A Biomechanical Study of Rotator Cuff Tear Progression

2018 ◽  
Vol 46 (8) ◽  
pp. 1919-1926 ◽  
Author(s):  
Felix Dyrna ◽  
Neil S. Kumar ◽  
Elifho Obopilwe ◽  
Bastian Scheiderer ◽  
Brendan Comer ◽  
...  
Keyword(s):  
Rotator Cuff ◽  
Dynamic Testing ◽  
Correlation Coefficients ◽  
Biomechanical Study ◽  
Rotator Cuff Tears ◽  
Shoulder Abduction ◽  
Mean Values ◽  
Critical Shoulder Angle ◽  
Anterior Deltoid ◽  
Shoulder Angle

Background: Previous biomechanical studies regarding deltoid function during glenohumeral abduction have primarily used static testing protocols. Hypotheses: (1) Deltoid forces required for scapular plane abduction increase as simulated rotator cuff tears become larger, and (2) maximal abduction decreases despite increased deltoid forces. Study Design: Controlled laboratory study. Methods: Twelve fresh-frozen cadaveric shoulders with a mean age of 67 years (range, 64-74 years) were used. The supraspinatus and anterior, middle, and posterior deltoid tendons were attached to individual shoulder simulator actuators. Deltoid forces and maximum abduction were recorded for the following tear patterns: intact, isolated subscapularis (SSC), isolated supraspinatus (SSP), anterosuperior (SSP + SSC), posterosuperior (infraspinatus [ISP] + SSP), and massive (SSC + SSP + ISP). Optical triads tracked 3-dimensional motion during dynamic testing. Fluoroscopy and computed tomography were used to measure critical shoulder angle, acromial index, and superior humeral head migration with massive tears. Mean values for maximum glenohumeral abduction and deltoid forces were determined. Linear mixed-effects regression examined changes in motion and forces over time. Pearson product-moment correlation coefficients ( r) among deltoid forces, critical shoulder angles, and acromial indices were calculated. Results: Shoulders with an intact cuff required 193.8 N (95% CI, 125.5 to 262.1) total deltoid force to achieve 79.8° (95% CI, 66.4° to 93.2°) of maximum glenohumeral abduction. Compared with native shoulders, abduction decreased after simulated SSP (–27.2%; 95% CI, –43.3% to –11.1%, P = .04), anterosuperior (–51.5%; 95% CI, –70.2% to –32.8%, P < .01), and massive (–48.4%; 95% CI, –65.2% to –31.5%, P < .01) cuff tears. Increased total deltoid forces were required for simulated anterosuperior (+108.1%; 95% CI, 68.7% to 147.5%, P < .01) and massive (+57.2%; 95% CI, 19.6% to 94.7%, P = .05) cuff tears. Anterior deltoid forces were significantly greater in anterosuperior ( P < .01) and massive ( P = .03) tears. Middle deltoid forces were greater with anterosuperior tears ( P = .03). Posterior deltoid forces were greater with anterosuperior ( P = .02) and posterosuperior ( P = .04) tears. Anterior deltoid force was negatively correlated ( r = −0.89, P = .01) with critical shoulder angle (34.3°; 95% CI, 32.0° to 36.6°). Deltoid forces had no statistical correlation with acromial index (0.55; 95% CI, 0.48 to 0.61). Superior migration was 8.3 mm (95% CI, 5.5 to 11.1 mm) during testing of massive rotator cuff tears. Conclusion: Shoulders with rotator cuff tears require considerable compensatory deltoid function to prevent abduction motion loss. Anterosuperior tears resulted in the largest motion loss despite the greatest increase in deltoid force. Clinical Relevance: Rotator cuff tears place more strain on the deltoid to prevent abduction motion loss. Fatigue or injury to the deltoid may result in a precipitous decline in abduction, regardless of tear size.

scholarly journals The Arthroscopic Intra-Articular Stabilization of the Shoulder for Irreparable Rotator Cuff Tear: A New Technique Proposal

2021 ◽  
Vol 8 ◽  
Author(s):  
Pierfrancesco Luciani ◽  
Luca Farinelli ◽  
Luca De Berardinis ◽  
Antonio Gigante
Keyword(s):  
Rotator Cuff ◽  
Humeral Head ◽  
Biceps Tendon ◽  
Reverse Shoulder Arthroplasty ◽  
Supraspinatus Tendon ◽  
Biomechanical Study ◽  
Rotator Cuff Tears ◽  
Rotator Cuff Injuries ◽  
Superior Capsular Reconstruction ◽  
Significant Difference

Background: Superior capsular reconstruction (SCR) has shown good results in the management of irreparable rotator cuff tears due to the depressive effect on the humeral head, but it is a technically demanding and expensive procedure.Purpose: We hypothesized that an intra-articular neoligament that prevents the superior translation of the humeral head could give similar results in terms of the superior translation of humerus (STH) and range of motion (ROM).Study Design: To compare our proposed technique and the SCR, we conducted a biomechanical study on 10 porcine shoulders in a custom shoulder testing system.Methods: STH and total rotational ROM were quantified in the following four scenarios: (1) when the rotator cuff was intact, (2) after cutting the supraspinatus tendon, (3) after the reconstruction of the superior capsule by long head of the biceps tendon (LHB), and (4) after an arthroscopic intra-articular stabilization by an intra-articular graft. Our proposed technique provides the creation of a humeral and glenoid tunnel, the passage of a graft through these tunnels under arthroscopic guidance, and the graft fixation in the two tunnels. We analyzed the STH and total ROM in each scenario.Results: With respect to the STH, we reported that the present proposed technique is characterized by a significant reduction of superior translation at 0 and 45° compared to scenario 2. In addition, the comparison between our proposed technique and SCR showed a significant difference of the STH at 0° of abduction. Total rotational ROMs of the two tenchinques were similar to scenario 2. Therefore, the use of an intra-articular ligament that prevents the STH can restore shoulder stability in irreparable rotator cuff injuries at both 0 and 45° of glenohumeral abduction without apparently limiting the total rotational ROM.Conclusion: Our proposed technique could be an important treatment option in irreparable rotator cuff tears, especially in patients under 65 years in whom reverse shoulder arthroplasty (RSA) has shown poor results and many complications.

scholarly journals Five-year Follow-up of Arthroscopic Superior Capsule Reconstruction for Irreparable Rotator Cuff Tears

2019 ◽  
Vol 7 (3_suppl2) ◽  
pp. 2325967119S0019 ◽  
Author(s):  
Teruhisa Mihata ◽  
Thay Q. Lee ◽  
Akihiko Hasegawa ◽  
Kunimoto Fukunishi ◽  
Takeshi Kawakami ◽  
...  
Keyword(s):  
Rotator Cuff ◽  
Shoulder Function ◽  
Rotator Cuff Tears ◽  
Rates Of Return ◽  
Shoulder Range Of Motion ◽  
Superior Capsule Reconstruction ◽  
Significant Difference ◽  
Graft Thickness ◽  
Glenohumeral Osteoarthritis

Objectives: For irreparable rotator cuff tears, we developed a new surgical treatment—arthroscopic superior capsule reconstruction (SCR)—to restore superior shoulder stability, muscle balance, and shoulder function. The objective of this study was to assess (1) changes in functional outcome; (2) changes in graft thickness; (3) rates of graft tear; and (4) rates of glenohumeral osteoarthritis during a 5-year follow-up period. Methods: From 2007 to 2013, arthroscopic SCR using autograft of fascia lata was performed on 37 shoulders with irreparable rotator cuff tears. Seven patients were lost to follow-up. Consequently, 30 shoulders (mean age, 68.0 years) were enrolled in the study. Shoulder range of motion (ROM), American Shoulder and Elbow Surgeons (ASES) and Japanese Orthopaedic Association (JOA) scores, acromiohumeral distance (AHD), Hamada grade, and Goutallier grade were compared among before surgery, 1 year after SCR, and 5 years after SCR. Graft thickness, which was measured in MRI, was compared among 3 months, 1 year, and 5 years after SCR. One-way analysis of variance followed by Fisher’s LSD post-hoc test was performed for statistical analysis. In addition, rates of return to sport or work were investigated in those patients who had been employed (12 patients: 5 carpenters, 5 farmers, and 2 construction workers) or played sports (8 patients: 2 table tennis, 1 golf, 1 martial arts, 1 yoga, 1 badminton, 1 mountain-climbing, and 1 ground golf) before injury. Results: Both ASES and JOA scores after arthroscopic SCR improved significantly at both 1 year ( P < 0.001) and 5 years after SCR ( P < 0.001). ASES score at 5 years after SCR was significantly better than that at 1 year after SCR ( P = 0.02). Postoperative ASES scores at both 1 year and 5 years after SCR were better in healed patients (27 patients) than in unhealed patients suffering from graft tear (3 patients). Active elevation was significantly improved at both 1 year and 5 years after SCR ( P < 0.001). At five years after SCR, 11 patients were still working and one patient, who had returned to part-time work at 1 year, had retired. All 8 patients were still playing sport before their injuries at 5 years after SCR. AHD was increased significantly at both 1 and 5 years after SCR ( P < 0.001). There was no significant difference in AHD between 1 and 5 years after SCR ( P = 0.16). In the 27 patients in whom the graft remained intact, graft thickness did not differ significantly among 3 months, 1 year, and 5 years after SCR ( P = 0.67). Hamada grade was significantly improved at both 1 and 5 years after SCR (preoperative: 2.3 ± 0.8; 1 year: 1.3 ± 0.7; 5 years: 1.3 ± 0.7, P < 0.001). All patients who had graft healing had no progression of glenohumeral osteoarthritis during the 5-year follow-up period. Two of the 3 patients with graft tear were suffering severe glenohumeral osteoarthritis (with narrowing of the glenohumeral joint space) at 5 years after SCR. The Goutallier grade did not change significantly after SCR in any patients. Conclusion: In a 5-year follow-up study, arthroscopic SCR restored shoulder function and resulted in high rates of return to recreational sport and work. Shoulder function and ROM were likely to get better with time. Graft tear exacerbated the clinical outcome after SCR and caused glenohumeral osteoarthritis in 2 of 3 patients by 5 years after SCR. Graft thickness and postoperative AHD did not change significantly between 1 and 5 years of follow-up, suggesting that we can expect excellent functional outcomes with long-term follow-up. [Table: see text]

Effect of biceps rerouting technique to restore glenohumeral joint stability for large irreparable rotator cuff tears: a cadaveric biomechanical study

2020 ◽  
Vol 29 (7) ◽  
pp. 1425-1434 ◽  
Author(s):  
Sang-Yup Han ◽  
Thay Q. Lee ◽  
David J. Wright ◽  
Il-Jung Park ◽  
Maniglio Mauro ◽  
...  
Keyword(s):  
Rotator Cuff ◽  
Glenohumeral Joint ◽  
Biomechanical Study ◽  
Rotator Cuff Tears ◽  
Joint Stability

scholarly journals Could superior capsule findings be used as a predictor for partial bursal-sided rotator cuff tears?

2020 ◽  
Vol 28 (1) ◽  
pp. 230949901989515 ◽  
Author(s):  
Ulunay Kanatlı ◽  
Tacettin Ayanoglu ◽  
Erdinc Esen ◽  
Baybars Ataoglu ◽  
Mustafa Ozer ◽  
...  
Keyword(s):  
Rotator Cuff ◽  
Glenohumeral Joint ◽  
Arthroscopic Treatment ◽  
Rotator Cuff Tears ◽  
Subacromial Impingement Syndrome ◽  
Control Group ◽  
Study Group ◽  
Coracoacromial Ligament ◽  
Cuff Tear ◽  
Significant Difference

Purpose: The purpose of this study was to investigate the relationship between the superior capsule tear patterns and synovitis with subacromial pathologies, such as bursal-sided rotator cuff tear and subacromial impingement syndrome. Methods: Fifty patients who underwent arthroscopic treatment for isolated bursal-sided tear were included in the study. Fifty more patients who underwent arthroscopic treatment for isolated Superior Labrum Anterior Posterior (SLAP) 2 lesion without pathology in the rotator cuff were included in the control group. Firstly, superior capsule tear and common synovitis on the rotator cable were assessed during glenohumeral joint examination. Coracoacromial Ligament (CAL) degeneration grading was performed according to the Royal Berkshire Hospital classification. Bursal-sided partial tear grading was done using Ellman classification. Whether or not there was a relationship between synovitis, classic capsule tear, plus reverse flap capsule tear, and partial bursal-sided tear existence. Results: There were 21 patients with reverse flap capsule tear in the study group and 3 patients in the control group. In addition, there were 13 patients with synovitis in the study group and 4 in the control group. Compared to the control group, there was also a significant positive correlation in the presence of both synovitis and reverse flap capsule tear with the presence of bursal-sided tear in the study group ( p = 0.000). There was, however, no significant difference between the presence of classical capsule tear and the presence of bursal-sided tear ( p = 0.485). Conclusion: This study shows that the presence of reverse flap capsule tear and synovitis was associated with partial bursal-sided tears. Therefore, if the reverse flap capsule tear or synovitis is detected in the superior capsule, the rotator cuff should be evaluated in more detail during subacromial bursoscopy in order not to miss a bursal-sided partial cuff tear.

scholarly journals Irreparable Rotator Cuff Tears: A Biomechanical Comparison of Superior Capsuloligamentous Complex Reconstruction Techniques and an Interpositional Graft Technique

2019 ◽  
Vol 7 (8) ◽  
pp. 232596711986459 ◽  
Author(s):  
Tim Leschinger ◽  
Katharina Besch ◽  
Cansu Aydin ◽  
Manfred Staat ◽  
Martin Scaal ◽  
...  
Keyword(s):  
Rotator Cuff ◽  
Glenohumeral Joint ◽  
Supraspinatus Tendon ◽  
Rotator Cuff Tears ◽  
Neutral Position ◽  
Management Options ◽  
Significant Difference ◽  
Intact Condition ◽  
Point Condition ◽  
Biomechanical Comparison

Background: Irreparable rotator cuff tears lead to superior translation of the humeral head. Numerous surgical management options are available to treat the condition. Purpose: To compare superior capsule stability among different types of patch grafting in irreparable rotator cuff tears. Methods: Six cadaveric shoulders were tested in a custom-designed shoulder testing system. Superior translation of the humerus and subacromial contact pressure were quantified in an intact condition (condition 1), after cutting the supraspinatus tendon (condition 2), and after additionally cutting the superior capsuloligamentous complex (condition 3). The results were compared among 3 types of patch grafting, in which capsule reconstruction was achieved by glenoidal 3-point (condition 4) or 2-point (condition 5) fixation or by affixing a graft below the acromion (condition 6). Results: No significant difference in subacromial pressure was measured by reconstruction with 2 or 3 anchors compared with conditions 1 and 2 ( P > .05). However, with 3-point fixation, lower levels of pressure were measured than with 2-point fixation. Moreover, superior translation values were lower with 3-point fixation; the same applied for values of the preserved capsule as compared with the torn capsule. In condition 6, a significant increase in pressure in the neutral position was documented ( P < .05). Conclusion: The superior capsuloligamentous complex plays an important role in stabilizing the glenohumeral joint. The results suggest that with additional medial anchoring at the coracoid base, the depressing and centering effect of the superior complex can probably be regained in a more physiological way compared with a reconstructed capsule with 2 glenoid attachments or with an interpositional graft below the acromion.

scholarly journals Latissimus Dorsi Tendon Transfer with or Without Superior Capsular Reconstruction for Treatment of Irrepairable Rotator Cuff Tears

2018 ◽  
Vol 6 (7_suppl4) ◽  
pp. 2325967118S0010
Author(s):  
Anthony F. De Giacomo ◽  
Hithem Rahmi ◽  
Sevag Bastian ◽  
Christopher Klein ◽  
John Itamura
Keyword(s):  
Rotator Cuff ◽  
Latissimus Dorsi ◽  
Tendon Transfer ◽  
Rotator Cuff Tears ◽  
Dash Score ◽  
Vas Score ◽  
Superior Capsular Reconstruction ◽  
Significant Difference ◽  
Secondary Outcomes

Objectives: Treatment options for massive irreparable rotator cuff tears, in middle aged adults, consists of tendon transfer or superior capsular reconstruction (SCR). The purpose of this study was to evaluate if transfer of the latissimus dorsi tendon transfer is enhanced with combination of superior capsular reconstruction for treatment of massive irreparable rotator cuff tears. Methods: At a single institution, all consecutive patients undergoing transfer of the latissimus dorsi tendon with or without superior capsular reconstruction, between 2013 and 2016, for treatment of irreparable rotator cuff tears were evaluated. SCR, was indicated, in addition to latissimus transfer, for patients with impaired preoperative active abduction. All clinical notes, diagnostic imaging, and operative reports were reviewed in detail. Demographics, operative techniques, and radiographic parameters were collected and measured. Functional outcome scores were prospectively collected from patients. The primary outcome of the study was the Disability of Arm, Shoulder, Hand (DASH) score. The secondary outcomes of the study were the Visual Analog Scale (VAS) pain score, Single Assessment Numeric Evaluation (SANE) score, and the American Shoulder and Elbow Society (ASES) score. Results: At 3 years, there were a total of 26 latissimus dorsi tendon transfers performed in patients with irreparable rotator cuff tears. Of these, 8 patients underwent only latissimus dorsi tendon transfer and 18 patients underwent latissimus dorsi tendon transfer combined with a superior capsular reconstruction. Average age was 53 years old with the majority of patients being male (88%). The dominant extremity was involved in 22 (85%) of latissimus transfers and 14 (53%) of patients had previous surgery to address a rotator cuff tear. Follow-up, for the entire cohort, was on average 29 months. At final follow-up, there was no significant difference in physical examination or radiographic measurements between patients with latissimus transfer alone and those with latissimus transfer with SCR. All patients, undergoing either technique, showed significant improvement in both the DASH score (preoperative DASH=59.6, postoperative DASH=39.9, P=0.049) and VAS score (preoperative VAS=6.6, postoperative VAS=3.3, P=0.0006). However, those patients undergoing revision surgery, regardless of technique, showed significantly less improvement in the DASH score (P=0.005), VAS score (P=0.002), SANE score (P=0.005), and the ASES score (P=0.001). Transfer of the Latissimus tendon with SCR, in comparison to only tendon transfer, did not show any significant difference in the final DASH score (p-value=0.72). At the same time, there was no significant difference between latissimus transfer, with or without SCR, in the secondary outcomes of the VAS score(P=0.97), the SANE score(P=0.63), or the ASES score (P=0.74). Conclusion: This is the first study to report the outcomes of latissimus dorsi tendon transfer with superior capsular reconstruction in comparison to only latissimus dorsi tendon transfer for treatment of irreparable rotator cuff tears. The study suggests that transfer of the latissimus dorsi tendon in combination with superior capsular reconstruction, at short term follow-up of 2 years, may not significantly influence functional outcome. Rather, patients undergoing revision surgery, regardless of technique, may demonstrate smaller improvements in functional outcomes. [Table: see text][Table: see text]

scholarly journals Comparison of sleep quality, shoulder function, and quality of life in patients with different-sized rotator cuff tears

2021 ◽  
Vol 12 (8) ◽  
pp. 130-136
Author(s):  
Ozge Vergili ◽  
Birhan Oktas ◽  
Ibrahim Deniz Deniz Canbeyli ◽  
Halime Arikan ◽  
Fatma Cansu Aktas Arslan
Keyword(s):  
Quality Of Life ◽  
Rotator Cuff ◽  
Sleep Quality ◽  
Emotional State ◽  
Shoulder Function ◽  
Rotator Cuff Tears ◽  
Poor Sleep ◽  
Western Ontario Rotator Cuff ◽  
Significant Difference

Background: Many patients with rotator cuff tears suffer from nocturnal shoulder pain resulting in sleep disturbance, inability on shoulder function, and reduced quality of life. Aims and Objective: This study aimed to compare patients with different sizes of rotator cuff tears (RCTs) concerning sleep quality, shoulder function, quality of life, and emotional state. Materials and Methods: Forty-four patients (mean age 49.43±10.71) with different size of RCT were included in this prospective cross-sectional study. Patients were divided into two groups according to RCT size diagnosed with magnetic resonance imaging. Patients were evaluated with Pittsburgh Sleep Quality Index (PSQI), Constant Murley (CM) score, Western Ontario Rotator Cuff Index (WORC), and Beck Depression Inventory (BDI). Results: There was no significant difference between patients with small and large size RCT in terms of sleep quality, shoulder functionality, quality of life and emotional state (p=0.841, p=0.258, p=0.916, p=0.936, respectively). Conclusion: We demonstrated that patients with RCT had poor sleep quality, decreased shoulder function, poor quality of life, and normal emotional status, regardless of the tear size.

scholarly journals The Area of Impingement in the Throwing Versus Nonthrowing Shoulder of Collegiate Baseball Players: An MRI Study of the Simulated Late-Cocking Phase of Throwing

2021 ◽  
Vol 9 (3) ◽  
pp. 232596712199213
Author(s):  
Makoto Takahashi ◽  
Koji Iwamoto ◽  
Masahiko Monma ◽  
Hirotaka Mutsuzaki ◽  
Masafumi Mizukami
Keyword(s):  
Rotator Cuff ◽  
Glenohumeral Joint ◽  
External Rotation ◽  
Rotator Cuff Tears ◽  
Shoulder Abduction ◽  
Baseball Players ◽  
Greater Tuberosity ◽  
Internal Impingement ◽  
Collegiate Baseball ◽  
Cystic Changes

Background: During shoulder abduction and external rotation, internal impingement can occur when compressive forces between the greater tuberosity and the posterior glenoid rim pinch the undersurface of the rotator cuff. Previous studies on internal impingement have focused on qualitative results such as pathological findings; however, few studies have quantified the area of impingement (AOI) of the rotator cuff muscles between the greater tuberosity and the posterior glenoid rim. Purpose: To compare the AOI between the throwing and nonthrowing shoulders of baseball players. Study Design: Controlled laboratory study. Methods: A total of 14 asymptomatic male collegiate baseball players participated in this study. The AOI in both the throwing and the nonthrowing shoulders was calculated using magnetic resonance imaging (MRI) scans. The MRI measurements were collected with the shoulder at 90° of abduction and at 90° and 100° of external rotation. The area, width, and depth of impingement as well as cystic changes in the greater tuberosity and degeneration in the posterior labrum were compared between the throwing and nonthrowing shoulders. Results: The AOI was significantly greater in the throwing shoulders than in the nonthrowing shoulders (90° of external rotation: 32.4 vs 19.1 mm2, respectively; 100° of external rotation, 28.0 vs 15.6 mm2, respectively; P < .001 for both). Compared with the nonthrowing shoulders, there were more positive findings in the throwing shoulders regarding greater tuberosity cystic changes (0 vs 7, respectively; P = .006) and posterior labral degeneration (3 vs 13, respectively; P < .001). Conclusion: The AOI and the number of lesions in the greater tuberosity and posterior labrum were greater in throwing shoulders than in nonthrowing shoulders. Therefore, damage to the insertion of the rotator cuff muscles may affect internal impingement. Clinical Relevance: Lesions in the greater tuberosity and posterior labrum in throwing shoulders may increase the AOI by expanding the joint gap behind the glenohumeral joint. Impingement of the greater tuberosity and the posterior glenoid rim may lead to rotator cuff tears.

scholarly journals Use of Gracile and semi-tendinosus tendons (GRAST) for the reconstruction of irreparable rotator cuff tears

2021 ◽  
Vol 22 (1) ◽  
Author(s):  
Marie Protais ◽  
Maxime Laurent-Perrot ◽  
Mickaël Artuso ◽  
M. Christian Moody ◽  
Alain Sautet ◽  
...  
Keyword(s):  
Rotator Cuff ◽  
Donor Site ◽  
Anatomical Study ◽  
Donor Site Morbidity ◽  
Rotator Cuff Tears ◽  
Subacromial Space ◽  
Greater Tuberosity ◽  
Working Zone ◽  
Superior Capsular Reconstruction

Abstract Background Irreparable rotator cuff tears are common and difficult to treat. Techniques for “filling the loss of substance” require fixation to the rotator cuff stump (tendon augmentation) or to the glenoid (superior capsular reconstruction), which are complicated by the narrow working zone of the subacromial space. The main objective of this study was to determine whether a braided graft of gracilis (GR) and semitendinosus (ST) could fill a loss of tendon substance from an irreparable rupture of the supra- and infraspinatus, by fixing the graft to the greater tuberosity and the spine of the scapula. Methods This was a cadaveric study with the use of ten specimens. The GRA and ST tendons were harvested, braided and reinforced with suture. An experimental tear of the supraspinatus (SS) and upper infraspinatus (IS) retracted at the glenoid was made. The GRAST transplant was positioned over the tear. The transplant was attached to the greater tuberosity by two anchors and then attached to the medial third of the scapular spine by trans-osseous stitching. The percentage of filling obtained was then measured and passive mobility of the shoulder was assessed. We proceeded to the same technique under arthroscopy for a 73 years old patient whom we treated for a painful shoulder with irreparable cuff tear. We inserted a GRAST graft using arthroscopy. Results The Braided-GRAST allowed a 100% filling of the loss of tendon substance. Mobility was complete in all cases. Conclusion This technique simplifies the medial fixation and restores the musculo-tendinous chain where current grafting techniques only fill a tendinous defect. The transplant could have a subacromial “spacer” effect and lower the humeral head. The donor site morbidity and the fate of the transplant in-vivo are two limits to be discussed. This anatomical study paves the way for clinical experimentation.

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